I'm 5'8", 145 lbs, 36c. My dr has suggested I consider a large implant-505cc-to restore some fullness to my deflated breasts. Originally I had considered a lift w/ a 350-400cc silicone hp but he said w/my fair skin it may not be worth the scarring & the implant alone would give me a 'pseudo lift'. Im afraid this will give me a 'bottoming out' look. I'm not looking for perfection, just improvement. Also, he suggested with the sufficient breast tissue I could go for saline & save myself some money.
Lift or Lift W/ Implant? (photo)
Doctor Answers (17)
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A breast lift or breast implant?
Thank you for your questionand for your photographs.
Based upon the pictures that you sent it appears as though the nipple on both sides is above the level of the fold. The glandular tissue that hangs down beneath the folds is called pseudoptosis.
Because in this situation the breast is not overly droopy it may not be worth the scars of a breast lift at this point in time. In this situation an implant which will restore upper pole fullness of the breast will also give some elevation to the soft tissue.
Even with an augmentation you will have some degree of droop beneath the implant because your natural degree of breast tissue will always respond to gravity. In my opinion even with an implant a little bit of droop can lead to a more natural-looking result and is not always a bad thing.
While silicone gel implants tend to feel more natural a patient like yourself with a good amount of natural breast tissue will hide either a silicone or a saline implant well. A saline implant will have more fullness in the upper portion and give you more elevation of the breasts than a silicone implant. A high profile implant which projects more will give more elevation than a moderate profile implant.
In summary, if you do not wish to be larger obviously, avoid an implant but you may wish to consider a full lift as long as you are comfortable with the scars.
If you do wish to go larger and try to avoid a lift an implant would steer you in the right direction, but just be sure that you are comfortable with the increase in size. Given your figure a high profile implant is reasonable as long as it satisfies your goal but it will certainly make you quite busty.
In my own practice I have patients try on implant sizers in the office to get a sense of what they will see postoperatively. I always tell my patients to go with the size breast they like, and not what they will think will avoid a lift. Once I know the size that the patient likes that I can give them a better estimation of whether they will need a lift after restoring volume.
Lift Would Help Avoid "Bottoming Out" Look You Say You Don't Want
It sounds like you have a good instinct that simply filling the sagging breast would just give you a bigger sagging breast. A good breast lift, with breast implants if desired, would give you the look you're describing you want. While the initial scars on fair skinned women stand out, over time they tend to diminish and fade quite nicely.
Big implants instead of a lift?
Your photos tell a lot. You have stretchy tissues, bottom-heavy breasts, and already probably look pretty good in the right bra. It is common for surgeons to tell you ,"Don't worry about it. Just put in big implants and it will give you a lifted look". Unfortunately what really typically happens is exactly what you are concerned about. Your tissues have already stretched just from the weight of the breasts you have. If you add a 500 cc implant you'll be adding more than a pound per breast. That's going to stretch. You are likely to end up with breasts that are lower than you want, bigger than you want, and without much fullness toward the top (the "ski-slope" area). From your pictures, I think you'll be much happier with the smaller implants and a lift. The scars are a "trade-off", but most women are happier with shapely proportional breasts with faded scars than breasts that are way too large and too low.
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Choices on breast implants v. breast lift
This is a tough question to answer without a "in person" exam. It seems that your nipple position along with your breast position seem a little low. If that is the case, then a breast lift is indicated and can be taken care of as part of the implant placement. Only use a breast implant if you are trying to increase the size of your breasts. If your breast tissue can cover the implant well, then saline implants are always an option as is placement of the implant on top of the muscle. Best wishes!!
Breast Augmentation with or without Lift
Many women, especially after pregnancy and breast feeding, find themselves in a similar situation as yours. The position of your nipple isn't too low such that a lift is "needed", but the skin of your breasts has clearly stretched out. The dilemma is to lift or not to lift along with the implant that will be placed for volume. The lift will help address the loose skin and improve the breast shape, but the trade-off is more scarring. The decision is very personal, as the "better" operation may be to lift with the implant, but it may take years for the scarring to really fade. You will be the one who will have to live with that. Best of luck.
Lift with or without implant?
This is a common question among women considering breast rejuvenation. Although breast scars are typically not desirable, the alternative of overfilling the breast to attempt a lift is a poor substitute. The hanging lower glandular tissue will always be visible spoiling the overall shape of the breast. Also, an often too large implant will stress the tissues further, making the original problem worse. Be skeptical if one consultant's operative plan deviates significantly from the other opinions obtained. Otherwise, your final result may not be what you want.
Lift and/or Implant
You have what is called pseudoptosis. That is a breast that looks droopy but the nipple is still above the fold. What has happened is that the lower pole has stretched giving you the bottom heavy look. The recommendation by the other surgeon will just give you a larger bottom heavy breast. It will not look youthful. I have my patients try on implants and pick the size that fits their frame and desired look. Then we do whatever type of lift is needed to restore a youthful appearance to the breast. Your fair skin typically heals beautifully. Ask to see pictures of the surgeons work. Don't hesitate to get more than one consult. Good Luck!!
Implant to Lift?
Large implants in a sagging breast will only leave you with larger, sagging, breast with now a bizarre, top heavy appearance. Over time, the implants will settle into a dropped out position (especially if they are placed over the muscle) and leave you with even more sagging. Additionally, restoring fullness in a large breasted woman does not require a 500 cc implant.
Given your fair skin, scarring from a surgeon expert in breast lifts are unlikely to be significant, and the shape that is gotten will be superior to anything else.
Best of luck!
Lift or Lift W/ Implant?
Another option would be full lift with fat grafts after liposuction. Or add a small implant to the mix. Just another look at your issues. Good luck.
Breast Implant with Lift
Thank you for the photos. Your nipple positions are not low however the images suggest a relatively large breast envelope with inferior pole laxity. Treatment with a large implant alone will likely give way to descent of the implant and recurrence of the bottom heavy appearance in the long run. A smaller implant with mastopexy tightening of the breast envelope is more likely to yield better upper pole fullness and a more stable aesthetic breast shape.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.